Claims Assessors - Braamfontein
Claims Assessors (Multiple) Financial Services Industry Contract - 12 Months Braamfontein, Johannesburg Job Purpose: Review and adjudicates claims in accordance with claim processing guidelines. Answer queries on the claims handling process and specific claims, whether those questions come from members directly, internal operations teams, account management teams, or brokers. Job Details: Analyze and approves claims. Proofs claim or referral submissions. Identify and investigate claims for possible abuse and fraud. Conducts outreach activities including but not limited to email, member calls, provider calls as part of the claims adjudication process. In accordance with prescribed operational guidelines, manages claims on desk, route/queues, and all systems within specified turn-around-time parameters. Utilizes all applicable system functions available ensuring accurate and timely claim processing service. Escalate unresolved claims complaints and high costs claims to the claims supervisor for guidance. Ensures compliance with requirements of regional compliance authority/industry regulator. Adheres to privacy policies, practices and procedures. Job Requirements: 2 - 4 years’ experience in a claims environment - Long Term Insurance Claim assessment experience - Long Term Insurance Has a detailed knowledge of Risk Products and relevant LTIA legislation Industry knowledge - Long term Insurance Advanced knowledge on Excel Matric Relevant Financial/Insurance qualification Excellent Numerical skills - Billing Must be available to start on or before 1 July 2023.
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